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Medical Coding News Archives

New Standards for Electronic Funds Transfers

January 25, 2012:

Nichole VanHorn, Clinical/Technical Editor

An interim final rule published in the Federal Register January 10, 2012, describes two standards health plans must comply with to use electronic funds transfers (EFT) to transmit health care claim payments to providers. One of the regulations defines the standard format health plans must use when ordering, authorizing, or initiating an EFT with their financial institutions, and the other outlines the data the EFT must contain.

Comments on the Centers for Medicare & Medicaid Services (CMS) rule are due by March 12, 2012, and compliance with the adopted standards for EFT would be required as of January 1, 2014. The regulations have been issued in compliance with the Health Insurance Portability and Accountability Act (HIPAA) and Affordable Care Act.

According to CMS, the standards could reduce administrative costs for physicians, hospitals, and private and government health plans by up to $4.5 billion over the next 10 years. These reductions would be in administrative costs for doctors and hospitals, private health plans, states, and other government health plans. In addition, there would be environmental benefits from the use of EFTs; an estimated 800,000 pounds of paper would be saved and 2.2 million pounds of greenhouse gases avoided over 10 years.

The regulations are mandated by the Affordable Care Act (ACA), under which CMS is required to issue rules designed to streamline health care administrative transactions, encourage greater use of standards among providers, and increase the efficiency of standards.

According to CMS, future rules will address the following: 1) a standard unique identifier for health plans; 2) a standard for claims attachments; and 3) requirements that health plans certify compliance with all HIPAA standards and operating rules.

Covered entities must comply with the health care EFT standards by January 1, 2014.